02D2142240 CLIA NUMBER - WALMART SUPERCENTER PHARMACY 10-4474

Laboratory Demographics

  • CLIA Code: 02D2142240
  • Facility Name: WALMART SUPERCENTER PHARMACY 10-4474
  • Facility Address: 10096 KENAI SPUR HWY
    KENAI, AK
    ZIP 99611
  • Facility Phone: 907 395-0871
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RONALD B. WAGONER
  • NPI Number: 1285965772
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 02D2142240
LAB Type Pharmacy
Facility Name WALMART SUPERCENTER PHARMACY 10-4474
Street 10096 KENAI SPUR HWY
City KENAI
State AK
ZIP 99611
Phone 907 395-0871
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/8/2024
Certificate Expiration Date 1/7/2026
Facility Type Pharmacy
Lab Director RONALD B. WAGONER

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This page was last updated on: 9/29/2025